Hyperemesis Gravidarum

Definition

Hyperemesis gravidarum (HG) is an uncommon condition characterized by frequent, persistent, and severe vomiting and nausea during pregnancy. As a result, you may be unable to take in a sufficient amount of food and fluids. It can cause a weight loss of more than 5% of your pre-pregnancy body weight. This can also cause dehydration and vitamin and mineral deficiencies. Treatment may require hospitalization.

HG is a more severe form of nausea and vomiting of pregnancy (NVP, morning sickness). Morning sickness affects anywhere between 70% to 80% of pregnant women. HG is estimated to occur in up to 2% of pregnancies.

Causes

There are many theories about the causes of HG, but none have been confirmed. HG is a complex disease that is likely caused by many factors. Some of these include:

Vitamin B deficiency

Human chorionic gonadotropin (hCG)—hyperemesis is most severe during the period of highest hCG levels

Symptoms

Severe and persistent vomiting, beginning 4 to 6 weeks after conception, peaking at 9-13 weeks, and usually improving and ending by 14-20 weeks

Weight loss of greater than 5% of original, pre-pregnancy body weight

Decrease in urine output

Dehydration

Rapid heartbeat

Headaches

Confusion

Lightheadedness and fainting

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include the following:

Blood tests

Urine tests

Weight measurement—to determine if you have lost weight

Overall condition—ability to perform daily activities, psychological state of mind

Treatment

Treating HG symptoms early in pregnancy can make you less sick in the long run and can decrease recovery time. Because HG is caused by many factors that vary among women, it is difficult to find a treatment that works for everyone. Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Diet

Anti-nausea Medications

Reducing nausea, and thus allowing eating and drinking, will hasten recovery. Due to the risk of stating that a drug is safe for use during pregnancy, very few pharmaceutical manufacturers will say that their drugs are intended for a pregnancy condition like HG. However, doctors often recommend that women with HG take certain anti-nausea medications, balancing the potential benefits and risks. Talk to your doctor about the right medications for you.

A common and safe remedy is to take supplemental vitamin B6 (pyridoxine). The American Congress of Obstetricians and Gynecologists recommends that first-line treatment of nausea and vomiting of pregnancy should start with pyridoxine with or without doxylamine. Pyridoxine has been found to be effective in significantly reducing severe vomiting.

IV Hydration and Anti-nausea Medications

In urgent doctor visit situations, HG can be managed by IV fluids and vitamins. This can sometimes be done without hospitalization. Very rarely, some people require IV fluids throughout the entire pregnancy.

IV Nutrition

If you are unable to tolerate food by mouth, you may need to receive nutrition through an IV. This is called parenteral nutrition. A special kind of catheter is placed in a large vein and liquid nutrition is given. This can sometimes be done without hospitalization.

Alternative Therapy

Acupressure
may help to reduce nausea. Acupressure is when pressure is applied to
acupuncture
points.

Termination of Pregnancy

In extreme cases, induced abortion may be considered.

Prevention

Many of the conditions that lead to HG are not preventable. To help reduce your chance of nausea during pregnancy:

Avoid smells, foods, or other things that stimulate nausea

Eat frequent, small meals

Do not allow yourself to get too hungry or too full

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Morning sickness: nausea and vomiting of pregnancy. The American College of Obstetricians and Gynecologists website. Available at:
http://www.acog.org/~/media/For%20Patients/faq126.pdf?dmc=1&ts=20130806T1444487894. Updated December 2015. Accessed June 6, 2016.